Video Tutorial for Indocyanine Green Lymphography in Lymphatic Surgery.

Abstract

An accurate diagnosis for patients with lymphedema is crucial for treatment and surgical management. Lymphedema can be diagnosed with medical history, a physical exam, limb measurements, and medical imaging.1,2 There are many methods to evaluate lymphedema such as circumference measurements, volumetry, lymphoscintigraphy (LS), computed tomography, photon emission computed tomography, magnetic resonance imaging (MRI), MRI lymphangiography, and indocyanine green (ICG) lymphography.3–11 ICG is a fluorescent cyanine dye that remains within the blood and lymphatic vessels due to its high rate of binding to plasma proteins and therefore low extravasation rates. Thus, ICG is ideal for visualizing superficial lymphatic vessels when stimulated with fluorescent and laser light. ICG lymphography has a unique ability in demonstrating the structural disorders of lymph nodes, and it has a high accuracy in evaluating lymphedemas and lymphatic flow disorders.12 Mihara et al. found that MRI and ICG lymphography were superior to LS or computed tomography for the diagnosis of lymphedema. They suggest dual diagnosis by examination of the lymphatic system using ICG lymphography and evaluation of edema in subcutaneous fat tissue using MRI. Furthermore, Mihara et al. showed that ICG lymphography is superior to LS for diagnostic imaging of early lymphedema of the upper limbs.